(HealthDay News) — Malpractice reform may not keep physicians from ordering unnecessary and expensive tests, according to a study published in the New England Journal of Medicine.

Emergency department (ED) physicians in three states that enacted malpractice reform continued to order imaging tests and admit patients for treatment at the same rate, even though the law had been changed to make it more difficult for patients to sue them, according to researchers at RAND Corporation.

Two of the states, Texas and South Carolina, experienced no reduction in the average amount of money spent caring for each ED patient. The third, Georgia, had a 3.6% reduction in emergency room charges.

Researchers reviewed over 3.8 million Medicare patient records from 1,166 hospital EDs between 1997 and 2011. They compared care in the three reform states to care in neighboring states that did not pass malpractice reform.

The study authors found that ED costs actually increased slightly in Texas and South Carolina following reform, and patients were admitted to the hospital at the same rate as before. Doctors also ordered CT scans and MRIs at the same rate.

“If you’re looking at ways to decrease our national spending on health care or reduce waste, then you’re going down a blind alley if you’re spending your time thinking about malpractice reform,” lead author Daniel Waxman, MD, PhD, an adjunct natural scientist at RAND and a visiting associate professor of emergency medicine at the University of California, Los Angeles, told HealthDay.


  1. Waxman DA et al. N Engl J Med. 2014;371:1518-1525.